Alexandria: Never a Slow Day in the ER

People At Work

A patient arriving unresponsive by ambulance has received blood work, urine, a CAT scan of the head and x-ray of the chest before moving to the Intensive Care Unit. Moffa says it is a busy day with four high acuity patients in the ER at the same time.

It is 11:10 a.m. and the emergency room is full with light blue curtains drawn across the patient rooms lining the long hallway. Tia Moffa, Emergency Room nurse at Inova Alexandria Hospital, is currently monitoring a critical patient who was brought in by ambulance and was unresponsive upon arrival. Moffa said, "we did lots of tests — blood work, urine, cat scan of head, x-ray of chest. We currently have her on a ventilator." Moffa says the patient will be transferred soon to the Intensive Care Unit.

Beep beep BEEP!

Moffa said, "There are lots of beeps in this room — the ventilator, the pump, the monitor. We know what is normal, what is critical." This beep means the patient's blood pressure is elevated. "We closely monitor her vital signs since she is a high acuity patient." Moffa said, "it is a really crazy day with a lot of sick people," but she pauses for a minute. "We are always busy." Down the hall is a drug overdose, and a severe allergic reaction just came through the door.

Photo by Shirley Ruhe/Gazette Packet

Tia Moffa’s current patients at Inova Alexandria Hospital ER include a critical patient headed for ICU, a psychiatric patient and an elderly fall. She says this is a lighter load for her than usual because the high acuity patient demands special one-on-one services while in the emergency room.

Moffa is juggling her ICU patient with a psychiatric patient and an elderly fall with a head injury. "Normally I would have more patients, but my high acuity patient requires a lot of one-on-one services, and I can't step away for a long period of time." She says the emergency room is really busy today with four high acuity patients who all demand a lot of services before they are transferred to the ICU. "Our goal is to not to keep anyone waiting before seeing a doctor."

She says when a patient enters the door of the ER, he checks in out front. If he arrives by ambulance, the ER has received a call ahead of the patient's arrival so they know what to expect and can be ready. Then the patient is "sent back here and placed in the appropriate room." Moffa explains they have "express care" for things that are simple like a cut or a fall. She adds they also have great protocols for stroke or heart patients and rooms for psychiatric patients. Moffa said they see a lot of patients that could be seen by a primary care doctor "but what is considered an emergency to the patient may be different than to us. We see anyone who comes."

Photo by Shirley Ruhe/Gazette Packet

The emergency room serves any patient who comes in its doors. Tia Moffa said, “What the person considers critical may be different than our definition” and they don’t turn anyone away.

She steps around the end of the bed and opens her computer screen in the corner. Moffa says everything is on the computer including medical records and history, medications, all of the charts and monitoring of vital signs, and everything is private. Moffa's schedule is 7 a.m.-7:23 p.m. three days a week. She has been at Inova Alexandria Hospital for eight and a half years where she started as a patient advocate, then moved on to be an emergency medical technician (EMT). She has been in the emergency room for the past five years. "I enjoy the medical field when you get to help a patient. I remember a 42-year-old female who came in unresponsive. We found a massive blood clot in her lungs and did CPR. We work in teams here with 2-3 nurses and an EMT. In a few days we all got to go and see her. It was very rewarding.” Moffa says she likes the fast pace. "It's very exciting; you never know what the day will bring." In addition, she appreciates “the immediate results that you wouldn't get in a regular doctor's office."

Moffa has a four-year nursing degree which she describes as different general knowledge. Then you pick a field later. She received specialized training at Inova Alexandria Hospital when she was first hired, attended classes and then followed an emergency room nurse for about three months. As another nurse slips into the room, Moffa walks to the head of the bed where she injects medication into one of the many tubes hanging over the bed. Moffa explains when giving a high risk medication, a second nurse must sign off. Another faster beep beep. Moffa doesn't move. Just a regular beep.